这个病例我个人认为还是报ASC-H而不报ASCUS或AGC。理由如下：

1、细胞相对不成熟，初步排除在ASCUS和LSIL之外。

2、细胞如细胞之间相对界限清楚、缺乏腺上的立体感；尤其第一图和倒数第二图，鳞状上皮疑问不大；初步排除腺上皮。

3、HSIL的细胞异型性更明显，染色质分布更不均匀；核膜更不规则。

     即使可能活检出来的结果是CIN2及以上级别；这个病例我个人认为报ASC-H比较合适；建议做HPV检测或阴道镜检查。

 ASC, metaplastic type.  In my practice, most ASC will trigger high righ HPV test which has very strong predictive value.

Please do not call this HSIL because HSIL is a very significant diagnosis.  The chromatin is fine, not coarse; nuclear membrane very smooth, not irregular; nuclei kind of pale, not dark.  I would call this ASC because some nuclei are enlarged with uneven chromatin distribution and some nuclei are kind of piled up.  It is metaplastic type because N/C ratio is high and some area even shows residual glandular architecture.  Atypical metaplatic cells mimic HSIL, sometimes they are ASC, other times ASC-H, still other times, they are true HSIL.

When I am not sure it is ASC or AGC, i would call it ASC to get HPV test.  When i call AGC, no HPV is done and GYN docs do colposcopy directly.

谢谢各位老师的讲解，我觉得也应该发ASC-H，直接发HSIL有点冒险，今天再补传几张细胞学涂片，明天给大家传HE图片

 我从来都是那胆大的

HSIL

Dr. Yu: You are right based on ASCCP guidline. My recent paper including others indicates HPV tedsting is very usful for risk assessment for ASC-H. We did reflex HPV testing for almost all ASC-H cases (physicians choose), the same as in many other institutes.

Occasinally the clinicians pick to order HPV testing for ASC-US, but not for ASC-H. In this situation I may pick ascus to get hpv testing done even though the cells look like asc-h. If hpv is positive I cannot change back to asc-h, but I will write a comment to mention that some atypical cells with increased n/c ratio, dark nuclei et al. Colposcopy is strongly suggested to rule out HSIL. In our institute, reflaxing hpv testing have not routinely ordered by clinicians for AGC, even we try hard to introduce to the clinicians. For a lot of ?AGC cases (but cytotech called AGC already), I call them as ascus to have hpv testing. I will think over if I will add AGC diagnosis to this case when I know the hpv testing result. For many cases I feel the cytology features are not good enough to call agc, plus negative hpv, especially for young women.  I just call these cases ascus with Pap f/u.

We may treat each case individually. Just for your reference. 

My asc-h paper:

Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results.

Bandyopadhyay S, Austin RM, Dabbs D, Zhao C.

Arch Pathol Lab Med. 2008 Dec;132(12):1874-81.

这是活检片子，除了有个别挖空样细胞，一处鳞状上皮略增生外，没有更严重的病变，是活检没有取到？